Understanding Grief and Loss in Times of War and Disaster

There are many different kinds of losses we can experience in our lives. Indeed, loss in human beings has its beginnings in the birth process that separates the infant from the comfort and security of the mother's womb into a world where survival is conditional and predicated on individual responsibility. The presumable final loss is the end of the human life cycle caused by death. There are many losses in between those polarities that relate to the developmental and aging process in each life. All of these losses are expectable losses and our bereavement and mourning of these losses are colored by their expectability

Losses can be understood and processed more effectively when they are placed in a meaningful theoretical framework. Here are some examples:

1. Normal (expected) losses versus abnormal (unexpected) losses.

2. Universal losses versus special losses.

3. Chronic losses versus acute losses.

4. Mild losses versus severe losses.

5. Replaceable losses versus irreplaceable losses.

Unexpected losses, by definition cannot be anticipated or prepared for, and therefore impact people with a "rapid" challenge. Adjustment to an unexpected loss is difficult because of the suddenness of the demand to the person's psychic and emotional economy. Unexpected losses can be acute or chronic. A diagnosis of Alzheimer's Disease is unexpected, but it is a chronic loss that may feature many years of gradual decline for the patient and their loved ones for adjustment. Sudden death of a loved one through war, and natural disasters like the recent Tsunami are quintessential examples of acute unexpected losses, and place upon survivors the most severe adaptational demands.

Losses are considered to have more impact on people when they are irreplaceable, which means that they cannot be somewhat "undone." Loss of your car through theft may indeed be potentially replaceable - obviously, the loss of a loved one is not.

Therefore, understanding grief and loss in war and disaster means realizing that these are some of the most terrible losses experienced because they are unexpected, "special", acute, severe, and irreplaceable. The symptoms of these losses can be understood just as much as a post -traumatic stress disorder, as they are a part of bereavement.

THE SYMPTOMS OF TRAUMATIC LOSS-

Understanding and bearing the grieving process of traumatic loss is easier when you are aware of the symptoms that will be experienced. Traumatic loss can call forth:

1. Shock

2. Disorientation

3. Severe preoccupation

4. Hysteria

5. Acute suicidal feelings

6. Inability to function

7. Flashbacks

8. Amnesia

9. Severe phobic reactions

10. Startle reactions

11. Motor restlessness

12. Anxiety and Panic

These are certainly in contrast to the crying, sadness, preoccupation, anhedonia, and sleep disorders found with milder, more expectable losses.

STAGES OF GRIEF IN MILD AND TRAUMATIC LOSS

Denial. One can expect that traumatic losses will trigger some level of denial. Nature has provided people with the neuropsychological equipment to provide themselves with soothing body-based opiates that accompany denial and shock. This creates a stop-action, freezeframe period to buy the time involved to readjust.

Preoccupation with the Loss. Opening up to that which has been lost will involve various degrees of preoccupation with the loss itself. Many clinicians believe it is not the passage of time that heals but the rearrangement of ideas that are involved in the passage of time. Further they feel that the affect of sadness favor the slowing of mental processes which bring about more reorganization of ideas.

Griefwork or losswork is painful. It requires energy and expends energy. The bearing of emotional pain, physical symptoms, and the shifting of previous habits or thinking which now demand reorganization, frequently cause personal exhaustion and the normal challenges of life may be too great at this time.

Another aspect of the preoccupation stage of loss represents what Kubler-Ross referred to as "bargaining". In part, This term describes moments and sequences of the mental reorganization process, where the wish to return to the pre-loss stage is felt or expressed. The broad sweep of optimal adjustment will hopefully dictate that this interlude will become a simple double-check which points out that, in fact, what is lost is lost and will stay that way, and the mourning process proceeds.

The Tree of Loss. People undergoing loss may experience the return of previous losses, both resolved and unresolved. Clinicians are familiar with this phenomenon and remain aware that this presents an opportunity for additional resolutions. Each person has their own special tree of loss, which is based on the losses they experienced in their life from birth up until the present moment.

Completeness of the Mourning Process. How well the person proceeds from the preoccupation stage to the withdrawal of energy from the loss stage depends on how completely the griefwork has been done. Essential to this completeness are the confronting of painful feelings, dealing with unfinished business and guilt resolutions.

People may require some help to tie up their loose ends (unfinished business) from another human being or a trained professional when it seems they are unable to "move on". This may involve revisitations of old emotional scenarios and events, which keep the person stuck in the past.

The presence of guilt (the personal belief that one has done something bad as regards to their value system) is sure to retard the resolution of loss. Again, it may be necessary to seek professional help when the trauma of the loss or guilt is severe.

Withdrawal of Energy and Acceptance. When all of the above has occurred, the grieving person will slowly withdraw the old emotional investment in that which was lost (decathexis). This may initiate a reworking of the previous stages in miniature, with an ultimate arrival some time in the future of acceptance of the loss, a sure sign that resolution and "moving on" has occurred.

Reinvestment of Energy. The "final" stage of this process, reinvestment of emotional energy may take a very long time to reach after the previous stages. Many people that have experienced a traumatic loss may never reinvest their emotional energy out of a fear of further loss or because they remain somewhat emotionally disorganized. If the previous stages have been poorly resolved, the chances of optimal reinvestment may be slim to none.

Many people remain stuck in a pre-reinvestment state, haunting the interpersonal world, but never getting truly involved: they are like ghosts too frightened to move on. Other people remain "stuck" when they idealize the traumatic loss of their loved one and subsist on the bittersweet fruit of martyrdom.

Others who are more fortunate realize that loss is inevitable and decide that they are too unwilling to settle for a life crippled by fear of further loss. These people reinvest their emotional energy and take their chances in lives hopefully enriched by a deeper understanding of the many dimensions of loss.

Shermin Davis helped edit this article. She is private practice in Miami, Florida and can be reached at Srdavis@prodigy.net

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